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56 Cards in this Set
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- Back
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General Precautions
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don't pull anything out of the wall until you are sure it won't adversely affect the pt
don't begin mobility until you know where all lines go plan ahead |
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NG Tube
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keeps stomach empty, allows bowels to rest after surgery, feeding or medication
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Nasoenteric feeding tube
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more specific use of a tube through the nose
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Special considerations for nasoenteric tube
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can you turn off for mobility?
can you disconnect? watch for aspiration precautions check for flushing if feeding has been off for 15+ minutes |
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PEG stands for
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percutaneous endoscopic gastronomy tube
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Why use a PEG tube?
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long term feeding needs
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Special considerations for PEG tube
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watch the abdomen during mobility
stay 30 deg or above (head board) flush if off for >15 mins may be able to eat by mouth as well |
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ICP can be measured via catheter in these 4 places
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lateral ventricle
parenchyma subarachnoid space subdural space |
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Ventriculostomies are
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position dependent
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Fiberoptic transducer tipped catheter
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can go into ventricle and other areas
not position dependent |
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3 equipment for integumentary system
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wound VAC
pressure-relieving mattress pressure-relieving boot |
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2 equipment for peripheral circulation
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sleeves
anti-embolism stockings (TED hose) |
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RUE lead colors
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"clouds over grass"
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LUE lead colors
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"smoke over fire"
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Special considerations for BP measurement (sphygmomanometer)
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use the right size cuff
could do radial BP on obese pt avoid taking BP on arm with central lines, edema automatic BP machines may be misleading |
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Special considerations for BP measurement (arterial line)
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watch movement of extremity, maintain transducer at heart level
don't pull out an arterial line! |
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Pulmonary artery catheter
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triple lumen catheter
inserted into subclavian or internal jugular vein goes through right heart to pulmonary artery continuously measures hemodynamics |
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Purpose of central venous catheter
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measures central venous pressure
blood samples medication or fluid administration hemodialysis |
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Central venous catheter may be in place for how long?
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up to 2-4 weeks
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PICC
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peripherally inserted central venous catheter
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Port-a-cath and MediPort are examples of what?
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totally implantable intravascular catheters
1+ year |
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Groshong and Hickman are examples of what?
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Tunneled central venous catheters
6 months |
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Restrictions with tunneled catheters
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swimming and manual therapy
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Two types of pacemakers
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temporary
permanent |
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Special consideration with pacemakers
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HR may not change with exercise, so watch vitals and pt sx to determine exertion level
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Purpose of a chest tube
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to drain fluid and/or air from pleural cavity
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Chest tubes promote
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lung expansion
pleural healing recurrence prevention |
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Where are chest tubes inserted?
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at the 4th or 5th intercostal space, at mid or anterior axillary line
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Special considerations for chest tubes
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wall suction, can you unplug?
gravity dependent do not kink the tubing |
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Pulse oximetry measures
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pulse rate
oxyhemoglobin saturation (%SpO2) |
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Two types of pulse oximetry
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continuous
portable |
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Special considerations for pulse oximetry
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can be inaccurate
low is < 90 or 88% cold finger, nail polish can affect reading stop activity, take slow deep breaths to get SpO2 back up if a short cord, may be possible to remove for movement |
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Purpose of supplemental O2
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raise PaO2 to reverse or diminish hypoxemia
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Two types of supp O2
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nasal cannula
face mask |
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Nasal cannula can deliver how much O2?
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.5 - 6 L/min
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A face mask can deliver how much O2?
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up to 15 L/min
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Special considerations with supp O2
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Take a portable O2 tank if going to walk pt
careful with tubing make sure to measure pulse ox |
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Purpose of mechanical ventilators
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to alter pulmonary gas exchange, increase lung volume, and/or alter the work of breathing
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How does a mechanical vent work?
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inflates lungs with positive pressure
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Intubation is...
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the process of adding an artificial airway
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Positive pressure ventilator classifications (4)
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pressure cycled
volume cycled time cycled combos |
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1 + and 1 - to trach button
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+ allows speech
- exercise tolerance may be decreased |
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Ventilator spectrum
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1. control mode
2. assist control 3. assisted vent 4. SIMV 5. PSV 6. CPAP 7. extubation |
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NIPPV
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noninvasive positive pressure ventilation
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Who uses NIPPV?
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COPD pts in the hospital
pts with neuromm. diseases, long term use |
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3 things NIPPV can deliver
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assist/control
synchronous intermittent mech vent pressure-supported vent |
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Pressure control ventilation
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delivers preset pressure for predetermined time (usually lengthened inspiration)
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Settings for mechanical vents
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FiO2
positive end-expiratory pressure RR Vt inspiratory flow rate inspiratory to expiratory ratio sensitivity |
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What is FiO2?
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fraction of O2 in inspired air, kept below 60% (normal = 21%)
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What is PEEP?
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positive end-expiratory pressure (normal = 5)
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What can cause tissue damage if too high?
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tidal volume
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What is sensitivity?
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how much pressure change needs to occur before machine kicks in
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Alarms for mechanical vents
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high pressure (mucus plug)
low pressure (tube disconnection) high RR (pain, fatigue) low RR (fatigue, sedation) |
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Criteria for readiness to wean off vent
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spontaneous breathing
FiO2< 50% PEEP < 5cm SaO2>90% RR< 35 Vt> 325 ml RR/Vt< 105 |
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3 weaning methods
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SIMV: dec # of breaths/min by vent
T-piece: try breathing on own PSV: dec amt of pressure support |
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Indications of stress during weaning
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increased RR
paradoxical or rapid shallow breathing pattern SaO2< 90% change in HR change in BP agitation, panic, sweating, cyanosis, arrythmia, angina LOC |
